Archives for 2008
A new study released by the RAND corporation, a nonprofit think-tank, has found switching to a system using unique patient IDs for electronic health record management would reduce medical errors, increase efficiency and help protect patient privacy.
The RAND study, which compared unique patient identifiers with other patient-data linking techniques, concluded that unique identifiers would be superior to current systems that use statistical matching. According to RAND, statistical matching, which uses personal information such as name, address or social security number, returns incomplete medical records about 8 percent of the time. Meanwhile, using unique identifiers can reduce the number of errors while enhancing privacy by disaggregating individuals’ health data from their personal information, it said. RAND also estimated a substantial long-term savings, with an up to $11 billion cost compared with roughly $80 billion in annual savings, according to the study.
Deborah Peel, founder of Patient Privacy Rights, a privacy advocacy organization, disagreed with the study’s findings. “The study was funded, designed and set up to improve the bottom line of the data mining industries,” she said. “Centralized ID systems are privately destructive.”
Peel expressed support for a system of health trusts, independent institutions responsible only to those whose data resides there. In that system, people would be able to review their information to make sure it is accurate and complete, and provide detailed instructions about who can use the data. A health trust proposal (HR 2991) was introduced last year by Dennis Moore, D-Kan., but has not been marked up….
It’s been a decade since federal legislation called for the creation of a unique patient identifier — a number carried by each American linking patients to their individual health records — but concerns about privacy and security, reported way back in the July 21, 1998, Los Angeles Times, have stalled efforts to put the proposal into use.
Concerns still exist, but it may be an idea whose time has come, according to a Rand Corp. study releasedonline today. It turns out that the compromise fashioned to adhere to the 1996 Health Insurance Portability and Accountability Act mandating the creation of a system to accurately identify patients has resulted in a system in which privacy is at risk, while not doing enough to prevent errors.
Is Esther Dyson, the technology venture capitalist who is training to be an astronaut, genetically predisposed to a major heart attack? Does Steven Pinker, the prominent psychologist and author, have a gene variant that raises his risk of Alzheimer’s, which his grandmother suffered from, to greater than 50 percent?
Did Misha Angrist, an assistant professor at Duke University, inherit a high risk of breast cancer, which he may have passed on to his young daughters?
On Monday, they may learn the answers to these and other questions — and, if all goes according to plan, so will everyone else who cares to visit a public Web site, http://www.personalgenomes.org/. The three are among the first 10 volunteers in the Personal Genome Project, a study at Harvard UniversityMedical School aimed at challenging the conventional wisdom that the secrets of our genes are best kept to ourselves.
The goal of the project, which hopes to expand to 100,000 participants, is to speed medical research by dispensing with the elaborate precautions traditionally taken to protect the privacy of human subjects. The more genetic information can be made open and publicly available, nearly everyone agrees, the faster research will progress.
According to Wikipedia, a male African elephant can weigh up to of 26,000 pounds. That gives you some idea how ponderously depressing acting CMS Administrator Kerry Weems was as the first general session speaker Tuesday morning on Day Two of the 80th American Health Information Management Association convention in Seattle. Weems’ job was to give an account of present-day conditions in the healthcare industry.
“In 21 short days there will be an election,” Weems said. “Seventy-seven days after that, a new administration will be in office.”
So far, so good. But Weems didn’t stop there. No matter who wins the White House, Weems said, “the elephant in the room is the rising cost of healthcare.”
Then he proceeded to lumber through a deflating recitation of past healthcare costs and future cost estimates:
National expenditures on healthcare in 1980 were $364 billion, representing 9% of the economy.
By 2017, healthcare costs are projected to rise to $4 trillion and consume 20% of the economy.
The next year, 2018, the Medicare trust fund is projected to go bankrupt.
Right now, state Medicaid expenditures are on par with state spending for primary and secondary education.
The Kabuki we see in the transition to electronic health records obscures two obvious and fundamental issues: The nature of the confidentiality privilege for electronic records maintained by patients instead of doctors; and The right to avoid self-incrimination when medical records contain information that might result in criminal prosecutions.
Both issues deal with the legal rights patients have in their medical records. To be clear, this is not the same as the patient rights granted under HIPAA or the types of private sector commitments to not abusing use of medical records. We seem to have a grasp on these finer points.
Instead, there seems to be little enthusiasm for dealing with the more mundane non-health related issues that arise when patient data meets the court system and the criminal code. These more concrete and practical issues are the real posers.
A new Morpace Omnibus study, fielded in September, reveals that 48 percent of American adults support creation of a nationwide system of medical records, while 23 percent oppose such a system.
Susan Semack, Vice President of the Health Care Practice at Morpace, said the study also shows that 29 percent of consumers remain undecided regarding support of a system that would allow patients, physicians, and other health care providers to access personal health records through the Internet. She added that many of those surveyed also have little knowledge about the system.
“Four years ago President Bush signed an Executive Order mandating creation of a nationwide system of electronic medical records to facilitate the continuity of health care, but most people are not aware of this,” said Semack. She added that consumers do see some potential benefits in this system, including improved quality of care and a reduction of medical errors.
Is the government looking for terrorists in Americans’ electronic medical records? Admittedly, it’s an astonishing question, but for many months, this year and last, Congress was roiled in a contentious debate over the legality of a government electronic surveillance program in which, allegedly, the fiber-optic backbone of our nation’s telecommunications system was tapped as part of the war on terror.
Millions of medical records move over those fiber-optic lines, which sparked an interest in the implications of the war on terror for the privacy of those records. But tapping fiber-optic cables isn’t the only possible way for government intelligence services to access Americans’ private health information.
Opinions vary on the likelihood that the government is looking for terrorists in medical records. Some who have been interviewed for this story said flat out, “no way”; others, however, said they suspect the war on terror is being used as a cover for the mutual interests of the government, the healthcare data-mining industry and the fast-growing “surveillance industrial complex” to gain access to records that previously have been off-limits to them.